Letter by Jin-shan and Xue-bin Regarding Article, "Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain: Insights From the PROMISE Trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain)".

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HomeCirculationVol. 136, No. 22Letter by Jin-shan and Xue-bin Regarding Article, “Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain: Insights From the PROMISE Trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain)” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Jin-shan and Xue-bin Regarding Article, “Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain: Insights From the PROMISE Trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain)” He Jin-shan, MD and Li Xue-bin, MD He Jin-shanHe Jin-shan Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People’s Hospital, Beijing, China. Search for more papers by this author and Li Xue-binLi Xue-bin Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People’s Hospital, Beijing, China. Search for more papers by this author Originally published28 Nov 2017https://doi.org/10.1161/CIRCULATIONAHA.117.030674Circulation. 2017;136:2202–2203To the Editor:We read with great interest the article by Hoffmann and colleagues1 about the prognostic value of noninvasive cardiovascular testing in patients with stable chest pain. The article indicates that coronary computed tomography angiography (CTA) provides better prognostic information than functional testing in contemporary patients who have stable chest pain with a low burden of obstructive coronary artery disease, myocardial ischemia, and events. CTA operates by identifying patients at risk for nonobstructive coronary artery disease. This article is a randomized comparison of the ability of anatomic and functional testing to correctly classify risk in symptomatic patients and will have a large influence on the management of patients with stable chest pain.We have 3 suggestions. First, coronary atherosclerosis causing between 1% and 69% luminal narrowing has emerged as a significant and frequent finding that, although often not associated with myocardial ischemia, carries a substantial risk for major adverse cardiovascular events in comparison with patients without any coronary artery disease.2 CTA can visualize minimal nonobstructive coronary artery disease, even the plaques, and it can tell which kind of plaque is a high risk for causing clinical events. The coronary artery system has great compensation ability, and the functional test will be abnormal when the stenosis is severe and normal if not. CTA identifies additional at-risk patients and imparts better prognostic and discriminatory information than functional testing. Second, because CTA is preferable to functional testing in patients with stable chest pain, it should be used widely in clinical practice. Two areas of concern include allergy to the contrast agent and the x-ray dose. We need to improve the techniques to lower the x-ray dose and rate of allergy to the contrast agent. Third, functional testing provides better prognostic information in high-risk patients with severe stenosis, but during the testing, myocardial ischemia may be induced and leads to myocardial infarction for these patients. Considering both efficacy and safety, CTA is more suitable when managing patients with stable chest pain.He Jin-shan, MDLi Xue-bin, MDDisclosuresNone.FootnotesCirculation is available at http://circ.ahajournals.org.